Healing the Body Politic

El Salvador's Popular Struggle for Health Rights from Civil war to Neoliberal Peace

Sandy Smith-Nonini

Publication Year: 2010

Healing the Body Politic examines the contested place of health and development in El Salvador over the last two decades. It recounts the dramatic story of radical health activism from its origins in liberation theology and guerrilla medicine during the third-world country's twelve-year civil war, through development of a remarkable "popular health system," administered by lay providers in a former war zone controlled by leftist rebels. The ethnography contributes to the integration of medical and political anthropology by bringing the semiotics of health and the body to bear on cultural understandings of warfare, the state, and globalization.

Introduction: Theorizing the Body and the State

In this book I recount a series of underreported struggles over health rights in El Salvador that date to the beginnings of the civil war in the 1980s. I examine the potential for a nondualistic theory of the body politic, or what Bryan Turner (1992) has called “a biopolitics of the somatic society.” Used in this way, body politic refers to the implicit moral ecology and sense of social...

Part One: Exclusion and the Politics of Bare Life

1. Manufacturing Ill-being

After the cease-fire when I began studying popular health in Guarjila, a resettled village of northeast Chalatenango, I initially talked to patients I met at the clinic and then asked permission to visit them at home for a follow-up interview. At the end of one such visit in the open-air dining area of an elderly woman’s champa, I stood to put my notebook away when Marta Ramos, who had been describing her
granddaughter’s persistent cold, suddenly...

2. Repression's Repercussions

My excursions to Chalatenango from the capital began with a two-hour ride on a crowded bus. The Troncal Norte wound around the foothills of the extinct Guazapa volcano, a rebel stronghold during the war. The bus stopped briefly in bustling Aguilares, where pupusa stands lined the road, and young women assaulted the bus hawking El Salvador’s famous bean- or cheese-filled tortilla pies and refrescos (fruit drinks) in...

Part Two: War Against Health

3. Insurgent Health

The power to heal is the existential antithesis to the power to kill, and healing has been a common site of religious and political transformation in many cultures (Glick 1977). In Marxist traditions, Friedrich Engels’s 1845 study, The Condition of the Working Class in England, was the first scholarly effort to examine the health of the public as both materially related to capitalist expansion and a site for revolutionary struggle. For its part, Catholicism...

4. Low-Intensity Conflict and the War against Health

The prologue of this book recounts my 1989 investigation of a Salvadoran army ambush of an FMLN mobile clinic. Witnesses and forensic evidence concurred that a U.S.-trained Special Forces unit quietly mounted a 60-mm gun on a ridge above the camp and methodically machine-gunned ten patients and health workers while soldiers chased down Mexican doctor Alejandra Bravo Betancourt and a lay nurse who fled the scene, raping, torturing, and killing both of them (Smith 1989a). While one of the more egregious cases, this...

5. Pacification

Military literature is replete with references to the fact that a properly fought low-intensity conflict (LIC) cannot stand public scrutiny and therefore must entail what U.S. general John Galvin (1990) calls a “war of information.” The problems of public scrutiny go far beyond security considerations; they result from LIC strategy of muddying the criteria dividing military combatants from civilians—the same vital distinction...

Part Three: Health against War

6. The Anatomy of "Popular Health" in the Repopulated Villages

Four months after the 1992 cease-fire, I began a study of the popular community health system that had developed (with assistance from the Salvadoran Catholic Church) in repopulated communities of northeast Chalatenango. Sometime after midnight on August 31, while sleeping in the back room of the clinic in Guarjila, I was startled awake by a baby’s shrill cries. In the examining room I found Esperanza, a peasant woman who had arrived the previous afternoon, wringing her hands while three health workers bent over a tiny infant. Tears coursed down Esperanza’s cheeks as Dr. Ana Manganaro...

7. The Elusive Goal of Community Participation

The famous 1978 Alma Ata international health conference, which elevated primary health care (PHC) to the level of international policy, established the year 2000 as the target year for achieving “Health for All.” As the millennium turned
over, the failure to meet the goal received little fanfare in the media. For health development specialists, it was a failure long...

Part Four: War by Other Means

8. Popular Health and the State

Although most political analysts cited El Salvador’s legacy of inequality as a central cause of the war, the social reform goals of the revolution were only partially met after the 1992 cease-fire. FMLN achievements in the pact included demilitarization of the country, creation of a new civilian-controlled National Police, and a program to transfer land to ex-combatants and some squatter settlements. But in the rush to achieve...

9. Disinvesting in Health

The problematic peace process negotiations between the Ministry of Health and community health leaders in Chalatenango were not surprising given the strained political relations between the right-wing ARENA government and its former enemy, the FMLN, whose leaders remained popular in this former rebel stronghold. To gain a wider perspective, in fall 1995 I examined postwar changes in less controversial parts...

10. The White Marches

Vice President Dick Cheney’s description of El Salvador as a “success story” (see chapter 1) is a revisionist nugget that neatly sums up the two countries’ foreign relations in recent years—based on renovation of ARENA from the party of death squads to advocates for a neoliberal business model. Wielding control of the legislature during most of the 1990s, ARENA...

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